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This definition is contrasted with cosmetic surgery performed to improve aesthetics or the appearance of a body part. [6] A plastic surgeon can perform both reconstructive and cosmetic procedures. Some procedures, such as a panniculectomy (aka tummy tuck) can be considered as cosmetic by one insurance company and reconstructive by another.
A national coverage determination (NCD) [1] is a United States nationwide determination of whether Medicare will pay for an item or service. [2] It is a form of utilization management and forms a medical guideline on treatment.
The main discussion of these abbreviations in the context of drug prescriptions and other medical prescriptions is at List of abbreviations used in medical prescriptions. Some of these abbreviations are best not used, as marked and explained here.
Medicare coverage is perhaps not as comprehensive as many Americans might assume. It can be extremely financially taxing to assume that Medicare will cover a certain set of procedures (or medical...
A medical biller then takes the coded information, combined with the patient's insurance details, and forms a claim that is submitted to the payors. [2] Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [4]
Prior authorization is a check run by some insurance companies or third-party payers in the United States before they will agree to cover certain prescribed medications or medical procedures. [2] There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic ...
Ladder: Ladder offers term life insurance policies without requiring a medical exam for coverage amounts up to $3 million. Applications for coverage under this amount can often be approved within ...
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.